Improving psychotherapy outcome: the use of immediate electronic feedback and revised clinical support tools.

The benefits of psychotherapy have been well documented; however, 5-10% of clients worsen while in treatment and another minority shows no response. The effects of feedback timing (delayed or immediate) and type (progress feedback and Clinical Support Tool [CST] feedback), aimed at reducing deterioration and improving outcomes, were examined in a sample of 1101 clients whose outcome was contrasted across experimental groups and with two archival groups: a delayed progress feedback and CST feedback group (n = 1374) and a treatment-as-usual control group (n = 1445). Progress feedback to therapists improved outcomes, especially for cases at risk for a negative outcome, but direct progress feedback to clients did not. Effects were significantly enhanced by using the manual-based CST. There were no significant differences in outcome between the 1-week-delayed CST feedback and 2-week-delayed CST feedback groups; however, clients in the week-delayed CST feedback timing condition attended three less sessions, on average, than their 2-week-delayed CST feedback counterparts while maintaining similar treatment gains. Results were interpreted as supporting the value of monitoring client progress and feeding back this information to therapists as well as assisting therapists in problem solving with cases at risk for treatment failure.